Sun Jiale, Gao Fuqiang, Wang Yanhua, Sun Wei, Jiang Baoguo, Li Zirong
The Graduate School of Peking Union Medical College Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China.
Medicine (Baltimore). 2017 Apr;96(15):e6621. doi: 10.1097/MD.0000000000006621.
Plantar fasciitis (PF) is the most common reason for heel pain. The efficacy of extracorporeal shock wave therapy (ESWT) as an ideal alternative to conservative treatments and surgery is controversial, and almost all previous articles compared general ESWT with placebo without indicating the kind of shock wave. We undertook a meta-analysis to compare the efficacy of general ESWT, focused shock wave (FSW), and radial shock wave (RSW) with placebo, to assess their effectiveness in chronic PF.
The PubMed, Medline, EmBase, Web of Science, and Cochrane library databases were searched for studies comparing FSW or RSW therapy with placebo in chronic PF. Clinical outcomes included the odds ratios (ORs) of pain relief, pain reduction, and complications. Relevant data were analyzed using RevMan v5.3.
Nine studies involving 935 patients were included. ESWT had higher improvement rates than the placebo group (OR 2.58, 95% confidence interval [CI] 1.97-3.39, P < .00001). ESWT had markedly lower standardized mean difference than placebo, with heterogeneity observed (standardized mean difference 1.01, 95% CI -0.01 to 2.03, P = .05, I = 96%, P < .00001). FSW and RSW therapies had greater therapeutic success in pain relief than the placebo group (OR 2.17, 95% CI 1.49-3.16, P < .0001; OR 4.63, 95% CI 1.30-16.46, P = .02), but significant heterogeneity was observed in RSW therapy versus placebo (I = 81%, P = .005).
This meta-analysis suggested that FSW therapy can relieve pain in chronic PF as an ideal alternative option; meanwhile, no firm conclusions of general ESWT and RSW effectiveness can be drawn. Due to variations in the included studies, additional trials are needed to validate these conclusions.
足底筋膜炎（PF）是足跟痛最常见的原因。体外冲击波疗法（ESWT）作为保守治疗和手术的理想替代方法，其疗效存在争议，并且几乎所有以往的文章都将普通ESWT与安慰剂进行比较，未指明冲击波的类型。我们进行了一项荟萃分析，比较普通ESWT、聚焦冲击波（FSW）和径向冲击波（RSW）与安慰剂的疗效，以评估它们在慢性PF中的有效性。
检索PubMed、Medline、EmBase、科学网和Cochrane图书馆数据库，查找比较FSW或RSW疗法与安慰剂治疗慢性PF的研究。临床结局包括疼痛缓解、疼痛减轻和并发症的比值比（OR）。使用RevMan v5.3分析相关数据。
纳入9项研究，共935例患者。ESWT的改善率高于安慰剂组（OR 2.58，95%置信区间[CI] 1.97 - 3.39，P＜0.00001）。ESWT的标准化均差明显低于安慰剂，存在异质性（标准化均差1.01，95% CI - 0.01至2.03，P = 0.05，I = 96%，P＜0.00001）。FSW和RSW疗法在疼痛缓解方面比安慰剂组有更大的治疗成功率（OR 2.17，95% CI 1.49 - 3.16，P＜0.0001；OR 4.63，95% CI 1.30 - 16.46，P = 0.02），但RSW疗法与安慰剂相比存在显著异质性（I = 81%，P = 0.005）。
这项荟萃分析表明，FSW疗法可缓解慢性PF的疼痛，是一种理想的替代选择；同时，对于普通ESWT和RSW的有效性尚无确凿结论。由于纳入研究存在差异，需要更多试验来验证这些结论。
